Thank you for sharing Dr Bricker. I am especially excited when you highlight the degree of transparency around claims data. Curious to learn more about cost between all the different actors in this healthcare system.
Thanks for these high-level policy videos. Very few people are making content like this, usually it's just the most basic/generalized health care info for the general public or it's info specific to public health.
Data quality, consistency, and availability problems are prevalent in the real MRFs published to comply with the Transparency in Coverage Final Rule. I imagine we will see the same with CAA compliance, and possibly even intentionally. Given the resistance and claimed IP resulting in these lawsuits, the CAA/ERISA/PHSA statutes need further specification on specific data elements, file/api formats, minimum reporting frequencies, and specific penalties for non-compliance.
Hi Dr. Bricker: thanks for another great video, very thoughtful and thought provoking. A lot of nuances regarding data sharing. In the wake of ‘DELAY. DENY. DEFEND. DEPOSE’, it seems totally necessary for insurance companies to disclose to the government and public about their practices that deny pre auth and claims, right? Does the government require insurance companies make disclosure of such data?
@@ahealthcarez “the government and its bureaucrats at CMS are the conspirators of the healthcare insurance companies on one hand and the enablers of abusive overcharges and over prescription of the providers on the other.” Is this a fair assessment?
@@ahealthcarez in the wake of “DELAY… DNEY… DEFEND… DEPOSE” shooting (that should be called), the government must require the insurance companies and healthcare providers make these transparent to American people. How else can any changes and improvements be made for the “members”?
Hi Dr. Bricker: would you consider doing a video or a series of videos on the practices of US healthcare insurance companies? In the wake of the “DELAY… DENY… DEFEND… DEPOSE”, there is a lot of interest - outcry really, on this topic. It’d be great to hear your opinions :)
Not sure why I found "St XYZ" and "St. 123" so funny 😁. This is fascinating stuff though, I've mostly worked on the public side of healthcare (Medicare and Medicaid) and our personal health insurance is through the health system my wife works for, the health system owns the health plan...... so the employer/union sponsored healthcare side is foreign to me. I didn't realize how much sponsored plans struggle to get price data .
I understand that self funded health plan would want to know how to save money on the health care costs. I don’t know if the employees want to their health information known by their employers and be told which hospitals or doctors to visit.
The information is known by the employee health plan. Not the employer… technically. Only specified HIPAA Privacy Officers can see it and they can have no input on firing, promotions, etc. Thank you for watching and for your comment.
Dr do you have an estimate of how many claims are attempted for adjudication each month or year in the US? Including retries. In my limited and distant experience with volumes of millions or billions of claims I observed a claim with 20 retries
Even if the carrier refuses to share claims data with the employer, can the employer not just access the pricing information through transparency in coverage machine readable files?
Thank you for sharing Dr Bricker. I am especially excited when you highlight the degree of transparency around claims data. Curious to learn more about cost between all the different actors in this healthcare system.
Thanks for these high-level policy videos. Very few people are making content like this, usually it's just the most basic/generalized health care info for the general public or it's info specific to public health.
Price transparency is important.
Data quality, consistency, and availability problems are prevalent in the real MRFs published to comply with the Transparency in Coverage Final Rule. I imagine we will see the same with CAA compliance, and possibly even intentionally. Given the resistance and claimed IP resulting in these lawsuits, the CAA/ERISA/PHSA statutes need further specification on specific data elements, file/api formats, minimum reporting frequencies, and specific penalties for non-compliance.
Agreed. Thank you for your detailed comment.
Hi Dr. Bricker: thanks for another great video, very thoughtful and thought provoking. A lot of nuances regarding data sharing. In the wake of ‘DELAY. DENY. DEFEND. DEPOSE’, it seems totally necessary for insurance companies to disclose to the government and public about their practices that deny pre auth and claims, right? Does the government require insurance companies make disclosure of such data?
Good question. No.
@@ahealthcarez “the government and its bureaucrats at CMS are the conspirators of the healthcare insurance companies on one hand and the enablers of abusive overcharges and over prescription of the providers on the other.”
Is this a fair assessment?
@@ahealthcarez in the wake of “DELAY… DNEY… DEFEND… DEPOSE” shooting (that should be called), the government must require the insurance companies and healthcare providers make these transparent to American people. How else can any changes and improvements be made for the “members”?
Hi Dr. Bricker: would you consider doing a video or a series of videos on the practices of US healthcare insurance companies? In the wake of the “DELAY… DENY… DEFEND… DEPOSE”, there is a lot of interest - outcry really, on this topic. It’d be great to hear your opinions :)
@ what do you mean ? The posts of Employees of Insurance companies on Reddit are the best info?
Thanks for the breakdown
Thank you for watching.
Not sure why I found "St XYZ" and "St. 123" so funny 😁. This is fascinating stuff though, I've mostly worked on the public side of healthcare (Medicare and Medicaid) and our personal health insurance is through the health system my wife works for, the health system owns the health plan...... so the employer/union sponsored healthcare side is foreign to me. I didn't realize how much sponsored plans struggle to get price data .
Thank you for watching and sharing your thoughts.
What CAA changes will come about as a result of the United Healthcare CEO?
I don’t know.
I understand that self funded health plan would want to know how to save money on the health care costs. I don’t know if the employees want to their health information known by their employers and be told which hospitals or doctors to visit.
The information is known by the employee health plan. Not the employer… technically. Only specified HIPAA Privacy Officers can see it and they can have no input on firing, promotions, etc.
Thank you for watching and for your comment.
Dr do you have an estimate of how many claims are attempted for adjudication each month or year in the US? Including retries. In my limited and distant experience with volumes of millions or billions of claims I observed a claim with 20 retries
Even if the carrier refuses to share claims data with the employer, can the employer not just access the pricing information through transparency in coverage machine readable files?
No. Files are intentionally indecipherable.
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